ArticleJHLT open2026
Prolonged warm ischemia time and unsuccessful heart resuscitation with thoraco-abdominal normothermic regional perfusion may negatively affect lung function in a preclinical DCD model.
Article in JHLT open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Thoraco-abdominal normothermic regional perfusion (TA-NRP) is increasingly used to resuscitate organs donated following circulatory death (DCD). Its impact on lung grafts is unknown. This preclinical study assessed, via ex-vivo lung perfusion (EVLP), lungs retrieved after TA-NRP resuscitation across varying functional warm ischemic times (fWIT). Methods: Pigs were subjected to fWITs of 15, 30, or 45 min after hypoxic cardiac arrest (n=4 per group), followed by 60 min of TA-NRP. A control group (n=4) underwent direct procurement (DP) after 30 min of fWIT. Lungs were cold-stored for one hour before EVLP evaluation. Lung function, gas exchange, hemodynamics, and inflammation were analyzed. Results: Cardiac resuscitation was successful for 15- and 30-minute fWITs, but not after 45 min. All lungs met ISHLT transplant criteria. However, WIT45 lungs showed higher pulmonary vascular resistance (aVR) (WIT45:673±95 dyn.s.cm⁻⁵, p=0.06), decreased compliance (WIT45:29±2 ml/cmH Conclusions: Lungs recovered after ≤30 min fWIT and TA-NRP remain viable for transplantation. However, prolonged WIT with unsuccessful cardiac resuscitation may adversely impact lung function. Strategies to ensure safe lung procurement in the setting of DCD TA-NRP are needed, especially in the context of prolonged WIT.
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